得宝松、甲氨蝶呤关节腔注射治疗类风湿关节炎及对MMP-3的影响

The Expression of MMP-3 in Serum and Synovial Fluid Derived from Patients with Rheumatoid Synovitis and the Effects of Treatment with Intraarticular Injecting the Combination of Diprospan and Methotrexate(MTX) on MMP-3

目的:观测类风湿关节炎(RA)患者关节液和血清基质金属蛋白酶-3(MMP-3)水平及得宝松、甲氨蝶呤联合关节腔注射治疗RA滑膜炎对MMP-3的影响,并探讨其作用机制。方法:选取类风湿关节炎滑膜炎患者48例,随机分为穿刺抽液并关节腔内注射得宝松、穿刺抽液并关节腔内注射得宝松和甲氨蝶呤2组,随访半年以上,应用酶联免疫吸附试验(ELISA)测定治疗前所有患者、治疗后复发患者再次穿刺治疗时血清和关节液MMP-3的水平以及6个月时随访到的患者的血清MMP-3水平。结果:治疗前、复发后患者关节液中MMP-3水平均明显高于血清水平且呈正相关,两组均能有效降低关节液和血清中MMP-3的水平,但联合用药组较单纯应用得宝松组更显著。结论:得宝松和甲氨蝶呤联合关节腔注射能有效的降低关节液和血清MMP-3水平,控制病情,改善预后。

Objective;To investigate the expression of matrix metalloproteinase 3 （MMP-3） in serum and synovial fluid（SF） derived from patients with rheumatoid synovitis and to study the effects of treatment with intraarticular injecting diprospan or the combination of diprospan and methotrexate（MTX） on it. Methods： 48 patients with clinical rheumatoid synovitis were divided into 2 groups randomly. They were aspirated SF from knee joints. The experiment group was treated with intraarticular injecting diprospan combined with MTX and the control groups were treated with intraarticular injection of diprospan only. Serum or SF samples were obtained from the paitents at baseline and the recurrent psitents after 6 month of treatment. The MMP3 concentrations in Serum and SF were determined with an ELISA technique. Results, MMP-3 levels in SF were significantly higher than that in serum. There was a positive correlation in MMP-3 levels between serum and SF, The serum and SF MMP-3 levels in the two groups were effectively suppressed, but that of the experi- ment group were significantly reduced. Conclusion： Serum and SF matrix metalloproteinase 3 （MMP-3） levels in the experiment group were significantly lower than that of the control group. Intraarticular injecting the combination of diprospan and MTX may prevent the progress of the disease in patients with rheumatoid synovitis.